Evolution of the Massachusetts Health Connector Lessons learned

Transcription

1 NASHP/Maximizing Enrollment State to State Exchange Exchange Experience: The Massachusetts Health Connector Kaitlyn Kenney Stephanie Chrobak Kerry Connolly March 2011 Agenda Evolution of the Massachusetts Health Connector Lessons learned Relationship between Health Connector Medicaid Current state Future state: National Health Reform Road map to

2 Evolution of the Massachusetts Health Connector 3 Why Health Reform in Massachusetts? 400, ,000 uninsured adults Improve health of the uninsured and provide financial safety net Free Care isn t free Strong starting point: high rates of coverage and employer-sponsored insurance existing insurance market reforms (guaranteed issue, no pre-existing coverage limitations, modified community rating, no medical underwriting) Political stars aligned 4 2

3 The Massachusetts Model: Shared Responsibility Residents: Individual mandate Government: Premium assistance Expanded Medicaid Employers: Make "fair" contribution Set up Section 125 Plan 5 Residents: The Individual Mandate 6 3

4 Employers (11+ employees) 1. Fair Share Assessment Make a fair and reasonable contribution to employees health coverage or pay state a fair share assessment of up to $295 per employee per year. 2. Section 125 Plan Requirement/Free Rider Surcharge Give employees option of paying premiums on a pre-tax basis (saves up to 40%). 7 Government Expand Medicaid and eliminate enrollment caps/restore benefits Children of families up to 300% FPL Insurance Partnership expanded to employees up to 300% FPL Premium subsidies for non-medicaid eligible low-income adults (Commonwealth Care) Hybrid commercial/subsidized approach Funding for outreach and enrollment Increased Medicaid rates 8 4

5 Additional Insurance Reforms Merger of small and non-group health insurance markets Expanded eligibility for family coverage for dependents (up to age 26 or loss of dependency status under IRS rules, whichever is sooner) Non-discrimination rules for fully insured market (e.g., cannot offer smaller percentage employer contribution to lower-salaried employees) 9 Role of the Health Connector Health Connector Board of Directors A&F Secretary Jay Gonzalez, Chair Terry Dougherty (MassHealth) Ian Duncan (actuary) Jonathan Gruber (health economist) Andres Lopes (small business) Lou Malzone (Taft-Hartley) Dolores Mitchell (Group Ins. Cmsn.) Joseph Murphy (Div. of Ins.) Nancy Turnbull (consumers) Celia Wcislo (labor) Health Connector Staff size: 49 Budget: $32 million Departments: Programs (Care/Choice) Legal Policy Finance IT Sales and Marketing Communications/ Intergovernmental Relations 10 5

6 Affordability Schedule & Minimum Creditable Coverage Who s subject to the individual mandate? Determined by affordability schedule established annually by the Health Connector Board Connector also has Appeals Unit to hear individual hardship claims What coverage complies with the individual mandate? Health Connector Board establishes rules for minimum creditable coverage 11 Commonwealth Care/Bridge: 180,000 members Connects low-income adults without ESI to subsidized health plans (enrollee premiums>150% FPL) Subsidized individuals 12 6

7 Commonwealth Choice: ~41,000 members Connects Massachusetts residents and small businesses to commercial health insurance Non-Group Small-Group Vol Plan Employers 13 Outreach By Health Connector Public Information Unit Partnerships with corporate and civic organizations including the health care community, faith communities, unions, business groups, sports teams, etc. Media Outreach/Direct Mail Seminars and forums (over 150 presentations) Grants to Community Organizations 14 7

8 High-Level Results of MA Reform % uninsured after 4 years (reduced disparities, improvements in access) 2. 97% compliance (taxpayer filings) 3. More employers offering coverage (76% in 2009), and more than 95% of employers are doing their fair share 4. 59% - 75% voter approval rating 5. Net new state costs ~ 1% state budget 6. Heightened focus on cost containment 15 Lessons Learned Importance of shared responsibility Individuals, employers, government, insurers Value of a phased approach 2007: Report insurance coverage as of 12/31/ : Report insurance coverage for each month of the tax year 2009: MCC regulations effective for each month of the tax year Importance of outreach, education, and stakeholder engagement 16 8

9 Real People Who Benefit 17 Relationship between the Health Connector and Office of Medicaid 18 9

10 Interagency Collaboration Connector utilized existing Medicaid systems and program standards as the foundation for Commonwealth Care - Fairness across state programs - Administrative simplicity - Consumer Protections - Rapid start-up - Executive and stakeholder sign-off Current functions performed by MassHealth on behalf of the Connector include: - Application processing - Eligibility determination and verification - Appeal adjudication - Analytics and Reporting - Customer Service - Provider interface 19 Eligibility MassHealth determines eligibility for all programs that use the Medical Benefit Request form - MassHealth - Children s Medical Security Plan - Healthy Start - Commonwealth Care - Health Safety Net Centralized eligibility system (MA-21) ensures applicants will be determined for the richest benefit available and allows for a smooth transition between programs with minimal lapses in coverage. MA-21 sends real-time eligibility information to state s enrollment and Medicaid claims processing system (MMIS)

11 MMIS MMIS (Medicaid Management Information System) is the state Medicaid claims processing and managed care enrollment system Services Provided: - Eligibility Verification System Web and Automated Voice Response system that gives providers access to current and complete member eligibility information on the date or date ranges services are provided - Enrollment system of record for MassHealth and Commonwealth Care members. MMIS serves as the business interface for participating health plans handling all transactions with the plans including payment. MMIS interfaces with multiple different programs, agencies, and health plans. This configuration creates less disruption as a member transitions between the health programs offered by different agencies. 21 Commonwealth Care Systems Commonwealth Care uses information stored in MMIS to operate a unique member servicing and premium billing system Commonwealth Care Member Web Portal - Members can enroll and pay premiums online - Displays personalized health plan options and premium amounts - Member health plan selection sent to MMIS. Health plans notified of enrollment on the daily 834. Interface with MMIS allows system to adjust premium amounts automatically as a member s income changes Commonwealth Care and MassHealth customer service and enrollment teams must work together to solve member issues 22 11

12 Member Process Flow Systems Integration is invisible to the member 23 Member Servicing Commonwealth Care members are serviced by multiple different agencies. Application support provided by MassHealth customer service platform Benefit support provided by Health Plan. Billing support provided by Commonwealth Care customer service. Eligibility support provided by MassHealth through Enrollment Centers and MassHealth customer service Enrollment support provided by Commonwealth Care customer service platform 24 12

13 Future: 2014 Consumers use Exchange to search for health insurance options available to them No wrong door What functions can be centralized? Using technology, Exchange collects basic information from the consumer (e.g. income, citizenship status, family status). Information is verified and (ideally) in real time, consumer is able to enroll in appropriate health insurance plan Simplified application and eligibility process Systems talk to each other behind the scenes Servicing teams will be in place to assist consumers High quality, affordable health plans are offered State/Exchange oversight and contracting functions in place Benefits offered are standardized and comprehensive 25 Future Exchange Shopping Experience Basic vision is one unified program, with new non-group (unsubsidized and subsidized) and small group policies offered in Platinum, Gold, Silver, Bronze and Catastrophic tiers Subsidized Individuals & Families (133%-400% FPL) Unsubsidized Individuals & Families (>400% FPL) Carrier 1 Carrier 2 Carrier 3 Health Insurance Exchange Platinum (90% AV) Gold (80% AV) Silver (70% AV) Bronze Catastrophic* (60% AV) Plan Plan Plan Plan Plan Plan Plan Plan Plan Plan Plan Plan Plan Insurance Carrier 1 Insurance Carrier 2 Insurance Carrier 3 Small Employers Carrier N Plan Plan Plan Insurance Carrier N 26 13

14 Future Framework 27 Roadmap to

15 Guiding Principles for 2014 State-wide planning for national health care reform has begun. As we build a model for 2014, our guiding principles are Offer essential health insurance coverage to individuals Define the population Define health benefits Work within fiscal realities Maximize and leverage financial resources Define subsidies & tax credits Focus on consumer simplicity Minimize disruption Understand their needs Create efficient administrative infrastructure Leverage technology Eliminate duplication Build off what we have learned over the past 4 years And challenge our own conventional wisdom 29 ACA Structure for Massachusetts A state-wide, Interagency ACA Implementation Workgroup was formed, led by Secretary Bigby of EOHHS The following agencies are represented Attorney General s Office Executive Office of Administration and Finance Group Insurance Commission Department of Revenue Executive Office of Health and Human Services Office of Secretary Department of Children and Families Department of Development Services Department Elder Affairs Department of Mental Health Department of Public Health Division of Health Care Finance and Policy Health Safety Net Health Care Quality and Cost Council Executive Office of Housing and Economic Development Division of Insurance Office of Small Business and Entrepreneurship Executive Office of Labor and Workforce Development Governor s Office Health Connector Workgroup holds quarterly meetings for stakeholders; updates and information posted on website

16 ACA Structure for Massachusetts Five major interagency subgroups have been formed Insurance Reform: Focused on implementation of short term and long term private insurance reforms Long Term Care/Behavioral Health: Focused on home and community based care issues including issues related to: dual eligible populations, the aged and the disabled, medical home and integrated care models, management of chronic conditions and behavioral health issues Employer: Focused on disseminating information to employers and on considering the interplay between the employer-related ACA provisions and the MA HCR provisions Healthcare Workforce: Focused on health care workforce development opportunities for the state and expanding awareness of health workforce loan repayment, scholarships and other opportunities for individuals and private institutions Subsidized Insurance/Medicaid: Focused on issues that impact MassHealth and the Connector and on the populations that are eligible for subsidized coverage and Medicaid 31 Exchange Planning In addition, Exchange planning efforts are underway State awarded $1M grant for Exchange planning activities Managed by Health Connector Funds solely used for research and planning Grant period: October 1, 2010 September 30, 2011 Submitted procurement timeline to our Grant Officer Procurement for consulting assistance In collaboration with other New England states, Massachusetts awarded $35M Early Innovators grant Additional Exchange grant opportunities available Used for infrastructure and operational development 32 16

17 Exchange Transition Planning Program Structure EOHHS-Led Inter-Agency Health Care Reform Implementation Work Group Consultant-Based Project Management Assistance Policy & Legal Workgroup Subsidized Insurance/ Medicaid Workgroup Exchange Executive Steering Committee Exchange Program Lead Team Health Connector Board Information Technology/ Business Operations Workgroup Stakeholder Engagement Product Assessment & Development Workgroup Small Business Workgroup Financial/ Accounting Workgroup Workgroups to be supported by appropriate consultant-based assistance, as necessary 33 Stakeholder Engagement for Exchange Planning Stakeholder involvement and transparency in Exchange planning is critical to its overall success Stakeholder engagement include a broad array of participants, including but not limited to: Advocates Health plans Providers Small businesses Working groups meet with stakeholders to request feedback and to review draft recommendations and plans Stakeholders are also engaged via periodic reports at public Health Connector Board meetings 34 17

18 Massachusetts Health Connector Speakers Contact Information Kaitlyn Kenney Director of Policy & Research and Coordinator of National Health Care Reform Massachusetts Commonwealth Health Insurance Authority Director Phone: Kerry Connolly Program Development Manager, Commonwealth Care Massachusetts Commonwealth Health Insurance Authority Phone: Stephanie Chrobak Director of Commonwealth Care Program Massachusetts Commonwealth Health Insurance Authority Phone: